Effectiveness of intraoperative ultrasonography for para-aortic lymph nodes in preventing unnecessary lymphadenectomy in ovarian carcinoma

Eiji Ryo, Tsunekazu Kita, Toshiharu Yasugi, Katsumi Mizutani, Michiharu Seto, Shigeki Takeshita, Takuya Ayabe

Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan.
Department of Obstetrics and Gynecology, Teikyo University, Tokyo, Japan.

DOI: 10.4236/ojog.2013.35A1002                

Abstract

Objective: To evaluate the usefulness of intraoperative ultrasonography (IU) for para-aortic nodes to identify women who do not require pelvic and paraaortic lymphadenectomy in ovarian carcinoma. Methods: Computed tomography (CT) was used for assessing both pelvic and para-aortic lymph nodes, and IU only for para-aortic nodes in 87 women with ovarian carcinoma. All women underwent surgery with routine systematic pelvic and para-aortic lymphadenectomy. We assumed that no lymphadenectomy had been performed when no enlarged node was detected by either CT or IU or when the woman was in T1 stage. Under these assumptions, the numbers of women who would have had missed metastases and who could have avoided lymphadenectomy were counted. These figures were recounted on the combination of T stage and IU. Results: A total of 22 women had pathological node metastases. The numbers of women with missed metastases on the basis of CT, IU, and T stage were 12, 2, 5, and these who could have avoided lymphadenectomy were 72, 39, and 49, respectively. There were more women avoiding lymphadenectomy by CT than IU and T stage; however, more women with missed node metastases. Both numbers were not significantly different between IU and T stage. On the combination of T stage and IU, 29 of 49 women in T1 stage could have avoided lymphadenectomy without missed metastases. Conclusions: IU for the para-aortic node is a useful method for identifying women who do not require lymphadenectomy for T1 stage ovarian carcinoma.

Keywords

Intraoperative Ultrasonography; Lymphadenectomy; Lymph Node; Lymph Node Metastases; Ovarian Carcinoma; Para-Aortic; Ultrasound

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Chan, J.K., Munro, E.G., Cheung, M.K., Husain, A., Teng, N.N., Berek, J.S., et al. (2007) Association of lymphadenectomy and survival in stage I ovarian cancer patients. Obstetrics & Gynecology, 109, 9-12.
[2]	Onda, T., Yoshikawa, H., Yasugi, T., Mishima, M., Nakagawa, S., Yamada, M., et al. (1998) Patients with ovarian carcinoma upstaged to stage III after systematic lymphadenectomy have similar survival to stage I/II patients and superior survival to other stage III patients. Cancer, 83, 1555-1560. doi:10.1002/(SICI)1097-0142(19981015)83:8<1555::AID-CNCR10>3.0.CO;2-R
[3]	Maggioni, A., Benedetti Panici, P., Dell’Anna, T., Landoni, F., Lissoni, A., Pellegrino, A., et al. (2006) Randomized study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. British Journal of Cancer, 95, 699-704. doi:10.1038/sj.bjc.6603323
[4]	Panici, P.B., Maggioni, A., Hacker, N., Landoni, F., Ackermann, S., Campagnutta, E., et al. (2005) Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimal debulked advanced ovarian cancer: A randomized clinical trial. Journal of the National Cancer Institute, 97, 560-566. doi:10.1093/jnci/dji102
[5]	Tempany, C.M.C., Zou, K.H., Silverman, S.G., Brown, D.L., Kurts, A.B. and Mcneil, B.J. (2000) Staging of advanced ovarian cancer: Comparison of imaging modalities; report from the Radiological Diagnostic Oncology Group. Radiology, 215, 761-767.
[6]	Ozalp, S., Yalcin, O.T., Polay, S., Aslan, N., Vardareli, E. and Adpinar, B. (1999) Diagnostic efficacy of the preoperative lymphoscintigraphy, Ga-67 scintigraphy and computed tomography for detection of lymph node metastasis in cases with ovarian or endometrial carcinoma. Acta Obstetricia et Gynecologica Scandinavica, 78, 155-159. doi:10.1080/j.1600-0412.1999.780215.x
[7]	Nam, E.J., Yun, M.J., Oh, Y.T., Kim, J.W., Kim, J.H., Kim, S., et al. (2010) Diagnosis and staging of primary ovarian cancer: Correlation between PET/CT, Doppler, and CT or MRI. Gynecologic Oncology, 116, 389-394. doi:10.1016/j.ygyno.2009.10.059
[8]	Ryo, E. (2008) Diagnostic value of intraoperative ultrasonography to assess para-aortic lymph nodes in women with ovarian and uterine corpus malignancy. Ultrasound in Obstetrics & Gynecology, 32, 91-96. doi:10.1002/uog.5366
[9]	Ryo, E., Yasugi, T., Mizutani, K., Kita, T., Takeshita, S. and Ayabe, T. (2011) Diagnostic usefulness of intraoperative ultrasonography in avoiding unnecessary paraaortic lymphadenectomy in women with endometrial carcinoma. International Journal of Gynecological Cancer, 21, 859-863. doi:10.1097/IGC.0b013e31821a35ef
[10]	Onda, T., Yoshikawa, H., Yokota, H., Yasugi, T. and Taketani (1996) Assessment of metastases to aortic and pelvic lymph nodes in epithelial ovarian carcinoma. A proposal for essential sites for lymph node biopsy. Cancer, 78, 803-808. doi:10.1002/(SICI)1097-0142(19960815)78:4<803::AID-CNCR17>3.0.CO;2-Z
[11]	Suzuki, M., Ohwada, M., Yamada, Kohno, T., Sekiguchi, I. and Sato, I. (2000) Lymph node metastasis in stage I epithelial ovarian cancer. Gynecologic Oncology, 79, 305-308. doi:10.1006/gyno.2000.5951
[12]	Burghardt, E., Girardi, F., Lahousen, M., Tamussino, K. and Stettner, H. (1991) Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer. Gynecologic Oncology, 40, 103-106. doi:10.1016/0090-8258(91)90099-Q
[13]	Morice, P., Joulie, F., Camatte, S., Atallah, D., Rouzier, R. and Pautier, P. (2003) Lymph node involvement in epithelial ovarian cancer: Analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications. Journal of the American College of Surgeons, 197, 198-205. doi:10.1016/S1072-7515(03)00234-5
[14]	Negishi, H., Takeda, M., Fujimoto, T., Todo, Y., Ebina, Y., Watari, H., et al. (2004) Lymphatic mapping and sentinel node identification as related to the primary sites of lymph node metastasis in early stage ovarian cancer. Gynecologic Oncology, 94, 161-166. doi:10.1016/j.ygyno.2004.04.023
[15]	Tsumura, N., Sakuragi, N., Hareyama, H., Satoh, C., Oikawa, M. and Yamada, H. (1998) Distribution pattern and risk factors of pelvic and para-aortic lymph node metastasis in epithelial ovarian carcinoma. International Journal of Cancer, 79, 526-530. doi:10.1002/(SICI)1097-0215(19981023)79:5<526::AID-IJC14>3.0.CO;2-#
[16]	Tangitgamol, S., Manusirivithaya, S., Sheanakul, C., Leelahakorn, S., Sripramote, M., Thawaramata, T., et al. (2003) Can we rely on the size of the lymph node in determining nodal metastasis in ovarian carcinoma? International Journal of Gynecological Cancer, 13, 297-302. doi:10.1046/j.1525-1438.2003.13192.x
[17]	Ahuja, A.T., Ying, M., Ho, S.Y., Antonio, G., Lee, Y.P., King, A.D., et al. (2008) Ultrasound of malignant cervical lymph nodes. Cancer Imaging, 8, 48-56. doi:10.1102/1470-7330.2008.0006